Management of Stable Vitiligo—A Review of the Surgical Approach

Abstract

At present, vitiligo is the most common depigmenting skin disorder, characterized by clearly demarcated discolored patches of various shapes and sizes. Depigmentation results from the initial dysfunction and subsequent destruction of melanin-producing cells, called melanocytes, which are located in the basal layer of the epidermis and in hair follicles. This review concludes that the extent of repigmentation, regardless of the treatment method, is greatest in stable localized vitiligo patients. The aim of this review is to provide an overview of the clinical evidence for which the vitiligo treatment method (cellular or tissue) is more effective. The treatment relies on multiple factors, ranging from patient skin predisposition for repigmentation to the experience of the facility performing the procedure. Vitiligo is a significant problem in modern society. Although it is a typically asymptomatic and not life-threatening disease, it may have significant psychological and emotional impacts. Standard treatment relies on pharmacotherapy and phototherapy; however, the treatment of patients with stable vitiligo varies. The stability of vitiligo more than often implies the exhaustion of the potential for skin self-repigmentation. Thus, the surgical methods that distribute normal melanocytes into the skin are crucial elements of these patients’ therapy. The most commonly used methods are described in the literature, with an indication of their recent progress and changes. In addition, information on the efficiency of the individual methods at specific locations is compiled in this study, and the prognostic factors indicating repigmentation are presented. Cellular methods are the best therapeutic option for large-sized lesions; although they are more exorbitant than tissue methods, they benefit from more rapid healing times and presenting fewer side effects. Dermoscopy is a valuable tool used to assess the further course of repigmentation, where it is of great value to evaluate the patient prior to and following an operation.

Long-Term Effects and Prognosis Following Suction Blister Epidermal Grafting in Vitiligo Patients

“…1 Surgical therapies are mainly used for stable vitiligo (no increase in size of existing lesions and absence of new lesions in the previous 12 months), especially for segmental vitiligo, or other types of vitiligo that have been unresponsive to medical intervention or phototherapy. 2 Until now, several surgical procedures have been available, which can be broadly classified into tissue grafting and cellular grafting. 3 In clinical practice, the most appropriate surgical procedures are determined based on the location and size of the depigmented patches, and multiple techniques can be used in combination.…”

“…Suction blister epidermal grafting (SBEG) is currently the most common type of tissue grafting because it achieves high repigmentation rate, relatively simple to perform, and can be applied to almost all parts of the body, including cosmetic areas such as the eyelids. 2,4 However, few studies have investigated the long-term outcomes and factors associated with prognosis following SBEG. This study described outcomes [repigmentation rate, adverse events (AEs), postoperative relapse, and impact on quality of life (QoL)] among vitiligo patients who underwent SBEG and explored demographic and clinical factors potentially associated with relapse.…”

A New Assessment Method of Vitiligo by Combination of Dermoscopy and Reflectance Confocal Microscopy

“…2 The stability of vitiligo is pivotal in planning the treatment regimen and especially important for selecting patients eligible for surgery. 3,4 Up to now, the Vitiligo Disease Activity (VIDA) score is currently the most widely used measurement instrument in clinical practice because of its convenience, but it is also limited by the strong subjectivity and poor specificity. [5][6][7] Therefore, it is essential to establish an objective and effective method to evaluate vitiligo stability and treatment response.…”